Interview with Mony Weschler, Chief Technology & Innovation Strategist at Montefiore Medical Center

March 8, 2016

Direct Consulting Associates recently had the pleasure of interviewing Mony Weschler, Chief Technology & Innovation Strategist at Montefiore Medical Center.

Please tell us a little bit about yourself.

I am a creative and driven leader with extensive experience (25+ years) spanning the full range of clinical IT and MIS operations in various leading academic healthcare systems and institutions. While specializing in imaging informatics, my subject matter expertise extends to all healthcare and IT including strategy and operations, with clinical expertise in Radiology, Cardiology, Pathology, Perioperative, Perinatal, Surgery, Pediatrics, Nuclear Medicine, Orthopedics, Ophthalmology, Pharmacy, ACO’s, Population Health, Bio-Medical and Innovation.

In the course of my career, I have had the opportunity to establish and solidify Montefiore’s reputation as industry leader for testing and integrating groundbreaking technologies, result in multimillion dollar cost savings by pioneering an innovative cross-training support model, maximize operating room availability and spearheading the clinical use of innovation and mobile solutions.

What fascinating projects are you currently working on?

Mentor to startups at Junto, PilotHealth and BluePrint Health, bringing new innovation and technology to improve healthcare.

3D printing – How to incorporate and expand the usage of 3D printing to improve personalized medicine and outcomes. Imagine printing an airway for an infant or a printed custom hip replacement. How about a printing the before and after for conjoined twins that need to be separated?

Population engagement – communicating with your clinical providers using secure texting and smart Apps. Getting appointment reminders, nutrition guidance from your health system.

Wearables – Advanced activity monitors being handed out in the school systems to help change behavior and tackle pediatric obesity and diabetes with wellness and no drugs.

What is the most challenging aspect of your job?

Changing culture in a system that is resistant to change.

You have over 25 years of experience in HIT. What or who do you attribute your success to?

A love and passion for what I do. No one can escape the healthcare system sooner or later a loved one or ourselves will need care. I am privileged to have made a difference and improved the care and experience of millions of patients.

Did you have a mentor(s)?

Yes, my career began at NYP in 1989 and back then it was called Columbia Presbyterian Medical Center. I was fortunate to have had mentors like the world renowned Dr. Paul Clayton, Dr. Bob Sideli, George Hripcsak, Clair Hill, and other great mentors and friends. What I really enjoy is mentoring others and infecting them with a passion for Healthcare IT.

How has healthcare IT changed since you entered the industry, and where do you see it going?

EPIC was but a thought in Judy’s mind. IBM, 3M and DuPont were in the clinical space mostly with the beginnings of Lab systems. Most large academic medical centers had large programing staffs on hand and were building their own systems on mainframes and AS400’s. There was very little technology and informatics being used in healthcare. In fact, when the first digital imaging modalities like CT’s arrived we printed films to read the studies. Everything was paper and sharing vital information to treat a patient was very difficult.

Today, one can say that technology is completely integrated and integral in how we treat patients. Without technology a system could not properly treat its patients.

With the current pace of innovation and technology we can see the vast improvements in care and outcomes. I see healthcare becoming better and more accessible to everyone. I see great changes similar to the changes in the banking industry experienced. I grew up going with my mother to the gothic bank my children have never been inside a bank. Patients in the near future will have access to virtual visits with their physicians and with the next generation of wearables and implantables your physician will be able to take care of you even before you get sick.

I recently published a piece on the clinical tricorder and how the Star Trek Vision is becoming a reality.

How will the emphasis on patient engagement change healthcare in the future?

We’re already communicating with our patients using SMS text and mobile smartphone technologies. The government has pressured healthcare providers to shift from a fee for service to a fee for performance that makes the system accountable for the health and well-being for the patients it serves. This is a big step in the right direction but it can’t be successful without the patient being engaged and taking care of themselves. Mobile and other technologies allow the provider to help the patient and care giver become engaged in their care. Key communications such as appointment and medication reminders, nutritional guidance, activity coaching and encouragement are essential in improving care and reducing costs. New technologies can monitor patients at home while providing early warnings of decompensation and risks.

How do you incorporate leading-edge healthcare technology systems at Montefiore?

Our innovation process enables me to be a mentor at local accelerators and incubators like Blueprinthealth, PilotHealth and Junto Health. As a member of HIMSS, RSNA, mHealth, MEMS, CES and others I have the opportunity to engage startups early and select the solutions that solve our biggest and most important challenges. Having 25 years of operational and strategic informatics experience I can best champion the new technologies across the Montefiore systems which includes the medical school, acute and ambulatory care, home health, care management, school health and everything in between.

A few years ago you said your challenge was to reliably deliver data to physicians regardless of their physical location in ways that fit and enhance their workflow. Is that still a challenge?

Yes, but it is much better in the last 5 years we really took advantage of mobile devices so today our clinicians have access to Fetal monitoring strips from labor and delivery, cardiac EKG’s, PACS images, EMR data, analytics, communications, collaborative platforms and secure image capture from anywhere. Tele-psychiatry is rolling out, Tele-stroke is next.

What has been the hardest part of pioneering the integrated healthcare delivery network at Montefiore?

It’s always the culture and the ability to take risk. You can’t change and service model if you don’t have the vision and the authority to go in and shake it all up. What makes is most challenging in healthcare is that lives and real people are involved.

What’s the most cutting edge application you’re seeing now? What other innovations might we see in the near future?

TYTOcare this is a device that enables a person to do self-evaluation that captures key vitals and images that enable a clinician to properly diagnose during a virtual visit.

Siri, Amazon Echo, Google Talk, these are just the beginnings of machine learning and what was once known as artificial intelligence. The next big change in how we interact with computers will make the keyboard obsolete and move us into the era of natural language processing where we can communicate with the computer simply by speaking to it. In the clinical world it will allow the clinician to focus once again on the patient and not struggle with the keyboard.

How do you find and develop talented employees at Montefiore?

NY is a great place for talent as the city is home to many universities, prestigious healthcare organizations, financial Mecca. Investing in and growing staff is important but key is partnering with the clinical teams and the knowledge that the systems you support directly impacts on the care that is being delivered to our patients. The best talent like to create and implement new and revolutionary technologies and at Montefiore that’s what we do. Being the parent company to Einstein School of Medicine and the top performing ACO in the country helps as well.

How do you retain top industry talent?

Mentor each staff member, know your people and put them in positions that helps them succeed.

What soft skills do you look for when hiring new talent?

Very soft… Bright, wants to learn, team player, motivated like to ask questions.

What are the most important characteristics an HIT leader needs to be successful?

A leader needs to lead and think out of the box and be willing to take risk. Healthcare is changing at an extraordinary pace the likes of we have never experienced before. IT is critical in the survival of our healthcare systems if a CIO makes the wrong call or no call at all the implications will resonate at the system level.

I have seen IT leadership undergo many phases during my career.

In the 90’s, IT was the dictator; we did things and the business had to do what was mandated. In 2000, after the Y2K nonevent, IT was beaten up and the clinical folks took over; we were servers and did whatever the business asked for even if it was not the right thing to do. Outsource years.

By 2010 CIOs were back at the table but reporting to CFO’s with limited influence there were also many transplants from the financial world and that is not a good fit.

My approach and advice is to always be a true partner with the clinical leadership and to do that you must understand the business you are in. Be a change agent, understand the big challenges and provide the solutions, engage clinical champions and break the mold by introducing new innovation and technology. Only the best and most confident HIT leaders will step into this role. Unfortunately, most fall short and that is a major reason that HIT lags so far behind other industries when it comes to accessibility, ease of use and the inability to share data between systems. There is hope though the population is demanding change and technology is a major change agent. HIT has come a long way in the past 25 years but I’m optimistic that the next 25 will be legendary.

Interview with Yiscah Bracha, PhD, Research Health IT Scientist, RTI International

January 20, 2016

Direct Consulting Associates recently had the pleasure of interviewing Yiscah Bracha, PhD, Research Health IT Scientist at RTI International.

Please tell us a little bit about yourself.

I started in “analytics” before that word was widely used, as a mathematics major in college, also in a private tutorial relationship where I learned Philosophy of Science. In my last year of college, I taught myself statistics, where the only way to compute parameters was by using the calculator bolted to the desk in the lobby of the Psychology Department. A few years later, I learned how to use MINITAB which was available through large mainframe computers with dumb terminals, and that made it possible to apply statistics in ordinary life, or at least a life where mainframe computers were ordinary. They existed at the manufacturing giant 3M, and for several years I taught their MS and PhD chemical engineers how to design experiments and analyze data using traditional statistical techniques, to improve their outcomes and processes. This is exactly what I would be doing decades later, in health care, but there were many circuitous twists along the way.

The first circuitous twist, and the one that moved me from manufacturing to healthcare, where I would remain, was serving as a master’s level statistician supporting a large, world-renowned, NIH-funded clinical trial for primary prevention of coronary heart disease in middle-aged men. While I was teaching at 3M, I had decided to go to graduate school and get a master’s degree in statistics. I figured that the degree would give me legitimacy, and a theoretical grounding in what I already was doing empirically, and also expose me to methods that I otherwise wouldn’t have stumbled across on my own. All that happened according to plan, and it wouldn’t have happened if I had gone to grad school directly after college, because both the world and I had to ripen a bit.

So I got the MS, and consulted a bit across multiple industries, and then accepted this job at the Coordinating Centers for Biometric Research, in the Division of Biostatistics at the University of Minnesota. It was blind luck, but I happened to stumble into a position that gave me opportunities to collaborate with some of the world’s leading MD/PhD clinical epidemiologists in chronic disease. I interacted with them routinely, learned how they thought, learned how to translate their clinical vocabulary into questions that could be answered with the data we had. It gave me publication opportunities, because I also could write; I not only was analyzing data, I also was preparing the manuscripts that shared what we found. The job also exposed me to these new technologies called “email” and “internet”; for years, I was the only person in my social circle who routinely used a computer for work, who was even aware of these new communication and information tools. But the really unique exposure, that informed many things that followed, was how the technology, data management and analytic functions were organized in this very high quality analytics shop. We were two hemispheres of the same brain: Tech and data management on one side, and analytics on the other. Each hemisphere had its own unique ways of processing and contributing to the world, they knew enough about each other to communicate, and together we did much more than each could do alone. I took this for granted at the time, not realizing how important it was until I got out of academic clinical trials research and into healthcare delivery.

I made the switch because I had lost interest in clinical trials, or more accurately, I had lost faith that randomized controlled clinical trials could produce information that was relevant in the real world. In the real world, the patients are the ones who walk through the door; they are not carefully selected like they are in trials. In the real world, nobody is giving patients their treatments and medications for free, nobody is following up with them assiduously to make sure that they are adhering to treatment protocols, nobody is making sure they return to the clinic for follow-up visits every few weeks or months. I was interested in the real world, and I imagined what the analytic possibilities could be if I was working with data that emerged from processes that took place in real life. It was the early 2000s, a few years after I made the switch (but many years before the passage of the Affordable Care Act), and in Minnesota, the large vertically integrated healthcare delivery organizations were one by one starting to implement electronic health record systems. The prospect of harvesting EHR data and using them for research was very exciting, and I got involved in that effort in the organization where I worked. We failed to attain our goal, which was to use these EHR data to identify and redress disparities in health outcomes and care, particularly in chronic disease. The goal was simply too aspirational for current state at the time, and ten years later, it still is aspirational in the place that first proposed it. But we did use the EHR to support a real-time, guideline based decision support tool that helped clinicians select the optimal treatment choices for asthma while they were with the patient in the clinic. That decision support tool could have been used to obtain real-life data about treatment choices and outcomes, which could have been analyzed to generate new kinds of evidence, grounded in the real world, but doing that required a sponsor, along with an acceptance of the “evidence” that emerged that way, and neither were possible while research and delivery were so distant from each other organizationally.

The project became the basis of my PhD dissertation, because along the way, I had returned to graduate school again, this time to get a PhD in Health Services Research and Policy. It seemed like a fitting discipline for how to work with real world data, learn from them, and apply the lessons back in the delivery environment. Once again I was interested in legitimacy, and theoretical grounding, and new methods for my analytic tool box, and once again it worked, except this time it took seven years! I finished the degree after I had moved to Cincinnati, to lead the Data Analytics team in the very robust and advanced quality improvement department at Cincinnati Children’s Hospital. Here I had the most direct opportunity to apply those early lessons from clinical trials about how to organize a team that produced high quality analytic results consistently, and during my tenure, I transformed our group from an undifferentiated collection of generalists to a well-organized multi-functional team comprised of specialists. We were good, and they still are.

I spent my last 18 months at Cincinnati Children’s working closely with the IT department, to design a set of technologies, staffing structures and governance models that would produce high quality analytics across the enterprise. This was the logical next step, because excellence required an organization-wide strategy for managing and governing its data assets, and IT had that responsibility. But I had been homesick for Minnesota almost from the first day that I arrived in Cincinnati, and eventually I left to come home. A few months ago, I joined a non-profit research firm, telecommuting from home. I’m back in the research world, and this time paradoxically applying some of what I learned in delivery to the research environment.

The world around analytics is accelerating very rapidly. What other “trends” are you seeing right now?

I’m seeing expectations that data from consumer wearables and medical-grand sensors will become routine elements of the health data ecosystem, and that analyses of these data will help patients, providers and researchers improve health. The data management and analytics worlds are not really ready to meet these expectations, but they are coming anyway.

What fascinating projects are you currently working on?

I’m currently part of a team that is preparing a proposal that responds to the President’s Precision Medicine Initiative (PMI). The initiative is hugely aspirational: One million Americans will be followed for many years, contributing self-reported data about their health states and disease, and also giving permission to harvest data from the EHR systems that their providers use, from the activity trackers and environmental scanners and biorhythm sensors that they wear, and from biospecimens they contribute. All these data are to be integrated and curated and made available for analysis not just to academic researchers, but also to participants and citizen scientists. The goal is to understand how lifestyle, environment, genetics, medical treatment, all affect individual states of health and disease. NIH Director Francis Collins recently gave an interview to Politico, which ran the story under the headline about the high hopes and mad schedule for PMI. Yep. The PMI is really pushing the envelope on what is currently possible, and it is great fun to learn about all the resources out there that can be leveraged to pull it together.

You have over 20 years of experience in HIT. What or who do you attribute your success to? Did you have a mentor(s)?

I’m not sure if I’ve “succeeded” in the conventional sense of the term. It is true that I’m now being invited by people like you to offer insights and opinions about data and analytics in healthcare, but that has a great deal to do with forces outside my control, such as changes in technology and public policy. I just happened to be available when the world started to ask for what I’d been seeking for a long time. For many years, I was on a lonely path, pursuing a vision that wasn’t widely shared. In that vision, we leverage data produced through ordinary life, grab hold of them, manage them, and analyze them using appropriate methods, to understand what is actually going on in ordinary life. The academic health research world did not consider this to be a legitimate vision, as it privileged data from randomized controlled trials (RCTs) above everything else, with an enormous infrastructure and huge funding streams dedicated to supporting RCTs. And the healthcare operations world did not understand what we were talking about. Less than ten years ago, the leading EHR vendors were mystified by this vision as well.

Much has changed and is changing rapidly, partly due to changes in technology that make the previously unthinkable almost routinely possible, a phenomenon that has punctuated my career several times, from college till now. Technology can indeed drive change, but often in very unexpected and unpredictable ways. Also, the Affordable Care Act has now, finally, created a set of policy levers that provide incentives to improve quality and reduce costs. It is as if the country and legislature finally realized that if we don’t get a collective handle healthcare cost and quality, we will be spending every last dollar on medical care that doesn’t make people any healthier. The ACA provided incentives to get the house in order, and the data and the analytics based on them are essential to making the change, and there now are technologies available that make both the data and analytics more accessible than ever before. Those EHR vendors that were bewildered by this talk of using their data for analysis are now offering products of their own in data warehousing and self-service analytic tools. The vendor space has exploded with data management and analytics products and services targeted to healthcare providers and health information exchanges.

But still, I must say that even with all the changes underway, widespread institutionalized vocabulary is still rooted in the past. For example, I recently found a 2011 web site put up by the National Heart Lung and Blood Institute, called Data Coordinating Centers’ Best Practices. I was hoping to find something about best practices for managing the dirty crude data emanating from EHRs, medical sensor technologies, etc. Nope. After all these years, this was about best practices for managing data from multi-site clinical trials.

So if personal/professional “success” means that I’m now perceived as a thought leader and expert (which, by the way, is not how I perceive myself, because daily I am aware of what I still don’t know), then the attribution goes to a determination to seek truth, and follow that path wherever it leads. It also goes to friendships and professional relationships with kindred spirits I found along the way. I didn’t do it completely alone; I always found partners who shared the vision, as odd as it may have been at the time. We supported each other and had fun together, and we did some things that were wildly creative at the time, and we kept each other going. So the determination to stick to the vision, and the friendships and professional relationships, got me personally to the point where I am now, but it wouldn’t be perceived as valuable if the world hadn’t caught up as well. Now the world is kind of overtaking us, which is a giddy sensation indeed.

What personnel are required to succeed as a data-driven organization?

Organizations that wish to become data driven need both producers and consumers of actionable information.

The producers are not single individuals, but rather individuals with complementary skills working together on multi-functional teams. The data produced by EHR and other systems are like crude oil coming straight out of the ground: The crude won’t run your car or heat your house until a lot of refining, transformation, and delivery takes place. The same is true for “data”. What you get from the system is crude; what you want is refined, actionable information. It’s a multi-step process to transform that crude data into the actionable information, and different personnel with different training and skills are required along the way. You need database engineers, people who know how to store data, keep them safe, manage inflows and outflows. You need people with skills at cleaning raw data, and mapping the contents to standardized terms so that they make sense for analysis. You need people with data architecture skills, who can package data together in forms that analytic users can navigate easily. You need people who know how to work with state-of-art self-service and visualization software, to create applications that give consumers the ability to answer questions on their own. And you need people with high-end analytic skills, who know how to deploy advanced analytic methods or who can develop them, to answer questions that don’t have readily apparent answers. Especially at the end of the process, where you’re getting closest to the consumer, the people fulfilling these roles must serve as communicative bridges as well, translating customer questions and concerns into something that can be addressed with available data, and helping the customer understand and interpret the meaning of what they are seeing.

That’s on the producer side of a data-driven organization. The consumer side is equally important. Culturally, there has to be a hunger for this kind of information, a determination to really know the truth, and to do what it takes to get that truth. There have to be people who demand self-service analytic tools, because they refuse to wait for the next available “analyst” to service them. They want to poke and probe into the data themselves, going to an “analyst” only when they realize that their quest for information has exceeded their ability to acquire it independently. Ideally this mentality is prevalent at the highest levels of leadership, because leadership sponsorship is required to invest in the resources required to satisfy that demand. If the demand exists without the leadership necessary to satisfy it, frustration and chaos will ensue, as everybody scrambles independently to meet their own informational needs.

What soft skills do you look for when hiring new talent?

I look for curiosity, a deep desire to learn. I look for determination to get to the truth, and an insistence on producing the highest quality work while realizing that you can’t allow the perfect to be the enemy of the good. I look for a service mentality, a desire to help others, and make others’ lives and jobs easier. I look for both confidence and humbleness: Confidence that there is a way to solve the problem at hand, humbleness in the ever-present awareness of what we still don’t know. I look for an ability and desire to work as a member of team, but also independently, as both are required to meet analytic needs.

Interview with Joe Vincent, Senior Vice President of IT, FirstMerit Bank

September 29, 2015

Direct Consulting Associates recently had the pleasure of interviewing Joe Vincent, Senior Vice President of IT for FirstMerit Bank. Mr. Vincent was kind enough to answer questions about his career, trends in technology, daily challenges he faces, and how he finds and develops top talent. 

Please tell us a little bit about yourself.

I am a Senior Vice President in IT for FirstMerit Bank. I’ve been at the Bank for 23 years in a variety of Technology and Management positions over that time, with considerable experience in IT Governance, and major technology initiatives. Over the past 5 years alone, my responsibilities have included 3 very successful mergers and acquisitions, as well as a major upgrade to our Branch infrastructure and Teller system software. I am a person who loves new technology, but also loves to work with people to determine technologies that can help them be successful, and ensure they can meet their goals.

I also have a passion for supporting Education. I taught Adult Education for quite a few years, and currently volunteer my time in support of Kent State’s Center for Information Services Program. As part of that work, I’ve participated in Business Leader meetings to review trends in the workplace, as well as actually participating in classes acting as a mentor to project teams. Amazing how real world the classroom can be – right down to one of the teams losing all of their work due to no backups!

What is the most challenging aspect of your job?

I typically see two challenges: effectively managing and motivating people, and managing customer expectations.

Most employees desire to do a good job, yet everyone is motivated differently. Identifying that motivation, and finding ways to cultivate it, takes time and dedication on the managers’ part. The flip side of the coin is that this is also the one of the most rewarding aspects of the job. Identifying someone’s true motivation, and finding a way to utilize it for the betterment of the employee, as well as the company produces a very highly motivated and high performing workforce. It is truly a sight to behold.

Managing expectations can also be a very difficult part of running an IT organization. There are always more desires, with competing priorities than time and resources available. Having a great working relationship with the business lines, and transparency on work being done are keys here.

How can IT identify what their businesses actually need and make sure the technology they choose is the right fit?

This is a great question, and one that I find absolutely critical. The answer is “Listen.” Empowering IT to develop a close relationship with the business ensures they have a greater understanding of the operation of the business, and its many needs. Many IT organizations have seen their business units hiring IT staff (commonly referred to as “shadow IT”) to ensure they get the appropriate technology in place to attain their goals. This is a direct reflection of IT not servicing their business requirements sufficiently. Many centralized IT staffs are very in-tune with their responsibilities for running the IT side of the shop, but fail to spend the appropriate amount of time understanding the needs of their business customers, to allow them to serve in a true consultative role. This, in my opinion is a critical mistake.

The other half of the equation is keeping up with the latest technologies. IT must be able to provide leadership to the business line once they have a full understanding of their needs. Only the combination of the two – listening, and understanding the latest technologies, can lead to a truly successful partnership.

How do you find and develop talented employees? How can organizations find, train, cultivate and retain championship-caliber IT players?

We find that talented employees tend to know one another, so employee referrals are vital to helping an organization find top talent. Once on board, identifying the employee’s goals, and ensuring appropriate training and mentoring to meet those goals is very important.

The other key to retention is creating a work environment where employees understand and embrace the IT strategy, feel empowered to ask questions, and come up with ideas to support it, execute on those ideas, and receive the credit for achieving the desired results.

Is the rise of “hyperconverged” data center platforms driving IT leaders to take another look at Virtual Desktop Infrastructure?

I believe it is. Even 5 years ago, Virtual Desktop Infrastructure technology was in its infancy stage. From a management standpoint, implementation was a very large investment in both time and people, which in many cases still resulted in suboptimal implementations. It is very different to put all of the desktops into a single environment, similar to terminals attached to a mainframe, but without the maturity in processes and systems within the environment that the mainframe has developed through many years of service. To think that a server, or storage could go down, and no one would have a desktop to work with was very unsettling to many managers at that time.

Today’s “hyperconverged” data center platforms are much more robust, and mature, providing a viable solution for virtual desktop implementation. Virtual Desktops still require a significant investment in hardware, software, and engineering resources, but the underlying technologies have begun to prove themselves much more redundant and reliable, thereby alleviating some of the earlier concerns.

How do you foresee fraud and cyber security evolving in 2015? How should leadership teams at financial services organizations approach this threat?

Cyber security will continue to be a major threat in 2015 and beyond. Organizations continue to ramp up spending to attempt to proactively address key security concerns such as patching, email phishing attempts, etc., but proactive efforts will never be enough.

With so many incidents of compromised customer credit card data, compromised personal data, and espionage being reported in the news, there is a real risk of damaging a company’s reputation, and alarming the consumer, either of which can be fatal to a companies survival.

The current belief is that it is not if a company will get hacked, but when. This has caused significant increases in expenditures throughout the industry for new and better detection and containment technologies, in addition to the normal focus on enhancing prevention of a cyber crime.

I believe integrating Security teams throughout the organization is key. Whether it is project architecture, coding architecture, or every day processes and procedures, the IT security team needs to be involved.

Are you seeing any trends right now in the industry?

Within the banking industry the major trend continues to be customers banking remotely. Foot traffic for monetary transactions in the physical branch continues to decrease as the Baby Boomer generation dies off, with more and more customers doing their banking online, and via their mobile devices. We consistently see reports in the news of banks consolidating their physical locations. This will likely continue in the years to come.

You have over 25 years of experience in IT. What or who do you attribute your success to? Did you have a mentor(s)?

I like to listen – listen to the needs of my customers, listen to the needs and ideas of my staff, and provide them the freedom to get the job done.

My success has been directly attributed to the teams I work with. With three major acquisitions / conversions in the past 5 years, our teams have just done an outstanding job working together. Teamwork is always the key!

How do you retain top industry talent?

Understanding the motivations of your top performers is key in their retention. With the labor market being as tight as it is, just offering a competitive salary is not going to get it done. Your top employees need to understand and believe in your mission, and need to feel empowered to make a noticeable contribution toward its success.

I also believe it is a mistake to micromanage. Top performers like to figure out the best way to accomplish the task at hand, then get it done. Micro-managing drains the creative energy right out of a top performer.

What soft skills do you look for when hiring new talent?

I look for interpersonal communication skills and teamwork. In this ever increasing digital age, interpersonal skills are becoming more difficult to find, and thus a key differentiator in candidates coming out of school. These skills are critical to their success in managing peer relationships, as well as relationships with supervisors and successful participation on project teams.

In my experience, a well functioning team will always significantly outperform the individual contributions of its members. It is truly fun to watch as a team tries, then comes together to exceed it’s goals!

What are the most important characteristics an IT leader needs to be successful?

For their customers, an IT leader needs to be a visionary. They need to understand the requirements of their business partners, and work tirelessly to ensure the latest, most effective, and most efficient technologies are made available to them to ensure they have every potential advantage in the marketplace.

For their teams, they need outstanding leadership and people skills. Their success, and the success of their teams and business partners, often require heroic efforts to meet timelines and achieve results required to give their business partners the “edge” they are seeking with technology implementations.

One final characteristic that I believe truly sets successful IT leaders apart is transparency. Individuals, regardless of standing in the organization need to know what you are thinking. I make it a point to ensure that in all of my interactions, I am as honest as possible with an individual. In discussions with others, this has consistently been one of the traits highlighted as truly important to them, and factoring in to their overall satisfaction with their manager, and subsequently their jobs.

Interview with Shirley Nickels, Founder and President of Sentact

August 20, 2015

Direct Consulting Associates recently had the pleasure of interviewing Shirley Nickels, Founder and President of Sentact. Shirley was kind enough to answer questions about herself, her career, how she acquires new talent, and advice she would give other women starting their careers in the IT industry.

Please tell us a little bit about yourself.

I am the founder and President of Sentact LLC. Since our founding, my role has evolved as our Company has progressed through its exciting lifecycle; from a start up with only a business concept, to an organization that supports healthcare organizations throughout the country. With our growth and the addition of great Sentact team members, I primarily focus my attention on our technology platform and how our existing (and future) healthcare users can more efficiently and effectively meet their objectives with its use in their delivery of care. That includes bringing use-case concepts to life with our expert development group and spending significant time with customers and potential customers understanding their needs today and in the future. Pairing those valuable insights from healthcare experts with Sentact’s core competencies produces exciting possibilities. Identifying future needs that we believe we can most effectively address, become the fabric of our technology road map.

My prior career experiences were focused on solving business process challenges in the IT services industry. I enjoyed breaking down a process into definable elements, assessing each step’s value and efficiency, then putting them back together in a manner that met a specific business need. In essence, that same concept is the foundation behind Sentact’s business model.

Ultimately, I am passionate about leveraging technology to simplify processes and maximizing resources to drive tangible outcomes.

You have over 15 years of experience in IT. What or who do you attribute your success to? Did you have a mentor(s)?

I attribute much of my success to my parents and upbringing. As a first generation American-born child of a large Filipino family, strong work ethic and values were instilled in me at a very early age. My parents immigrated here because of the great opportunities our country provided. They made sure that every one of us understood what was available to us if we applied the right effort. It has been the foundation of who I am. I was taught that you need to earn your keep and value every opportunity no matter how large or small.

Having that upbringing and the good fortune to be part of organizations and great leadership that fostered personal growth gave me the exposure needed to evolve my career path. I have also surrounded myself with like-minded individuals that have challenged both my personal and business goals.

Are you seeing any trends right now in the healthcare IT industry?

As the market expands and IT evolves and becomes more abundant, I find that integration with other systems to provide a broader solution is essential. By allowing for integrations between systems, healthcare organizations have a true solution that allows them to become more efficient as well as productive.

Another key trend in the healthcare industry is mobility. We are seeing more and more mobile devices being deployed throughout healthcare networks. Technology companies are challenged to offer mobile applications allowing support staff, physicians, nurses, and other healthcare employees in the field not returning back to a central office.

What is the most challenging aspect of your job?

We are extremely fortunate to have a customer base that includes many of the leading hospitals and brightest minds in the healthcare industry. It’s always exciting when they come to Sentact with new development ideas or use cases. The challenge however is ensuring that we stay focused on our platform’s core functionality and purpose and not steer away from the long term plan for our services. Maintaining a cohesive service platform that scales and can be appropriately supported by your organization today and in the future is critical.

How has Sentact been able to be so lean and continue to grow rapidly and stay ahead of the competition?

We’ve applied the same rigors to the composition of our organization that we do when we approach an implementation of Sentact for our customers. We simplify our internal processes, leverage technology and constantly re-evaluate our group’s effectiveness relative to our business objectives. It ensures maximum efficiency in everything we do. Our team reflects what we think is a thoughtful approach to making sure our customers receive the best service and support. You can’t grow without satisfied customers. In fact our customer referrals have been the number one source of new business opportunities for us. We have also designed Sentact’s technology to in part, minimize the typically required resources for onboarding a customer, administration of the application, and developing or enhancing the platform. Our resources are freed up to focus on new ideas and value enhancements that keep us a leader in our industry.

It’s exciting that you just went mobile! What else can you tell us about as far as what is on the horizon for Sentact?

Mobile is a big step for us. We recently launched our new platform that features enterprise capabilities, mobile solutions, interactive reporting, and analytics to enhance the user-friendly experience. This was a big undertaking for us and we are currently working on transitioning all of our customers to the new platform.

We are also very excited about the redesign of our BI reporting capabilities. By increasing the reports available to our users and enabling more analytics, our customers gain more insight into their operations to make an impact with the information. Additionally, we continuously explore strategic API’s to leverage our technology and expand its value within our customer base.

How do you find and develop talented employees? How can organizations find, train, cultivate and retain championship-caliber IT players?

Our best source for finding new associates has come from our existing team and in some cases, recruiting partners. Our ability to attract talented individuals lies in the excitement around our technology platform and its impact on the healthcare industry. I’d like to believe that prospective associates sense our passion and become more interested in being a part of it. Our ability to retain talented individuals lies squarely with our culture. Things like compensation and benefits are important. You have to be competitive. But we’ve found that Sentact’s culture is what keeps people here. We empower our team to innovate and lead. We foster and embrace a strong team environment that allows individuals to refine their skill set and enhance their professional experience and personal goals. There are always new and exciting challenges at Sentact that give our associates an opportunity to grow.

What soft skills do you look for when hiring new talent?

Communication and creativity are valued assets. Our development cycle moves fast and we need good communicators to voice their opinion and have thoughtful feedback. Being able to challenge existing process and workflows for alternative solutions keep our services ahead of the curve.

What are the most important characteristics an IT leader needs to be successful?

IT leaders today need to be able to listen and adapt. IT and healthcare are changing so rapidly that it can be difficult to keep up. A good strategy driven by the market is important, but adjusting your tactics to the current climate is critical to success and even survival.

We recently started a “Women in Business” group here at Direct Consulting Associates. As the founder of Sentact and with all of the success you have had, what is the best piece of advice you can give other women in the tech industry who might be starting out or facing challenges in their career?

That’s an interesting question. I’m mindful that we don’t live in a perfect world. Early in my career I didn’t view things through a gender identity prism. However, after my first experience being the only female as a quality assurance consultant of a large financial institution’s help desk of 10 males, I quickly realized how gender can indeed play a role in impacting the success you attain in your job. That experience taught me how important it was to persevere and maintain my confidence to make an impact.

And after many meetings where I’d find myself in a male dominated room, whether it is IT, facilities management, or C-suite executives, I know it’s imperative to make that first impression count as it can eliminate any underlying gender, age or race bias to allow you to really control the outcome.

Interview with Scott Leddy, MD, CMIO at Wake Forest Baptist Medical Center, NC

Scott Leddy, MD is the Chief Medical Information Officer at Wake Forest Baptist Medical Center in North Carolina. Dr. Leddy was kind enough to answer questions about himself and the direction of healthcare for John Yurkschatt, Recruitment Manager of Direct Consulting Associates. 

Scott, Please tell us a little bit about yourself.

I’m someone who has always held a fascination with technology and biology. I think at its core it’s an obsession with complex systems. When I was a kid I easily grew bored at family dinners and would sneak away into an office that had an Apple II computer. I wanted desperately to play games on it and taught myself to program, hoping I could build my own. Later in life I discovered nature’s programming language embedded in our DNA, which culminated in my eventually practicing medicine. I maintained my passion for technology however, so when EHR’s hit the scene, this serendipity led me to the role of CMIO.

How did you decide to move from being a practicing Physician into technology?

The hospital system I was working in as an emergency room physician back in 2001 began its journey to adopt Epic, and I started off simply attending a few advisory meetings to help steer the project. I was deeply critical of what was first offered, and so my administration wisely redirected my energy into deriving solutions to the problems I saw. As my efforts in this vein became successful, I found myself spending less and less time in my clinical practice and more time refining our EHR platform. Part time became half time, and within a few years I wound up being the organization’s first CMIO.

What fascinating projects are you currently working on?

I try and cultivate a few sideline projects at all times that aim to push the envelope of what we can accomplish by applying technology to healthcare — the very fun part of the work. A longstanding interest has been the application of Real Time Location Sensing (RTLS) in a care environment. I’m fascinated by what you can determine simply by knowing that a given piece of equipment is next to a given patient or caregiver in a certain location, and the opportunities for process improvement and automation that result.

We’re working on a host of RTLS applications presently at Wake Forest Baptist Health, from simple things like biomedical equipment management to far more complex ones like optimized patient flow. I see it as a great investment for our organization. Once the sensing infrastructure is in place it’s simply a matter of adding inexpensive tags and thoughtful logic to produce creative solutions to everything from hand hygiene monitoring to staff and patient safety.

I’m also passionate about how we create and improve EHR governance and demand management models. I’m always looking for better ways to empower end users with a sense of control over the technology they use daily at a personal level while balancing the strategic objectives of the organization. It’s an example of what I love about working in healthcare technology. It really is still in its infancy, with so much ground yet to be covered and mastered. After more than a decade in the field I’m still learning new things every day, appreciating new approaches and strategies. It’s challenging – it keeps you on your toes.

As the CMIO, how are you moving Wake Forest Baptist Medical Center toward Meaningful Use and ICD-10?

While the adoption of both ICD-10 and Meaningful Use are huge initiatives for any organization, I don’t believe their implementation varies significantly from the core strategies needed for any other aspect of successful EHR adoption. Our team strives to understand the technology we have to address the challenge, its strengths and weaknesses. We tailor the EHR build accordingly and then test to ensure that the paradigms and tools we’ve constructed match the needs of our users as closely as possible. Once we’re confident that we’ve done a good job with the technology at hand, it’s then a matter of ensuring we effectively train our users for the changes about to impact their world, from the concepts inherent to these initiatives to the details of how they will impact their day-to-day work. My team and I also strive to give our users a voice in the process, a sense of control, so they feel involved instead of imposed upon. Like any significant change we deal with, it’s not really about technology, it’s about people. It’s about good change management.

What are the biggest pitfalls organizations fall into regarding their Epic implementations?

I believe Epic offers a host of strengths as an EHR platform – it’s extremely comprehensive and connected, and offers a surprising array of possible customization from the enterprise level right down to the end user. These strengths can act as a double-edged sword, however, as they also mean that Epic is extremely complex. I think it can be tempting for organizations new to the platform to overextend the scope of their initial implementation. This can create a system that presents challenges for users to learn and adopt quickly. It can also create a build that could have benefitted from a little more experience on the part of both their implementation team and users, resulting in a need for significant optimization.

The other pitfall I’ve seen as a recurring theme in any EHR implementation, not only Epic, is succumbing to the inclination that this is an IT project. While technology certainly plays a central role in an Epic rollout, as I mentioned this is really all about people and how they work from day to day. Leadership has to be fully involved and working hard to ensure that people from every corner of the organization have a level of involvement and ownership in the effort. Failing to do so too often results in the EHR feeling like something that was imposed on everyone by IT, instead of a great new set of tools that, once learned, will provide a better way of getting things done. A good implementation creates the latter.

What is the biggest obstacle to broader clinical adoption?

There are a host of factors that challenge broad clinical adoption of EHR’s. One of the most challenging is the very complexity of healthcare delivery itself; the enormous amount of science and ever-changing knowledge needed to deliver good care; the vast amount of data we collect on every patient we treat; the dizzying array of methodologies and varied processes that are used to deliver care. These add up to produce a huge challenge for creating and adopting technology that helps providers make sense of all the information and variability they’re forced to deal with, especially in a way that remains affordable for even the smallest organizations.

The other extremely significant challenge I see is the ever-rising tide of regulatory and payer-induced expectations for adherence to prescribed process and data collection. I think for many providers this creates a sense that they’re being distracted from delivering care to meet the needs of coders, researchers and lawmakers. And since these expectations so often manifest in the EHR as a need to enter this extra bit of data here, make a few extra clicks there, it’s easy for them to start to resent the technology as simply a tool for advancing the agendas of those once removed from front line care delivery. Right now I think it’s a path of least resistance to place these expectations squarely on physicians and nurses, who are already stretched very thin to have the time it takes to deliver quality care.

You’ve worked in a variety of segments across healthcare; how has this affected your perspective on healthcare and the industry?

It’s given me a great appreciation for the enormous complexity of delivering quality care. There are so many competing perspectives and needs that have to be balanced and satisfied that it can overwhelm you at times. I’ve learned that to drive progress you have to be methodical, deliberate and patient. You have to strive for the incremental successes and let them add up. For so many of the challenges healthcare faces, in particular healthcare IT, there simply aren’t easy answers.

In some ways I see healthcare as the victim of its own success. We’ve really done amazing things in the past century to reduce human suffering and extend lifespan. But the cost, both in dollars and effort, has been enormous and only continues to grow. As an industry we need to learn how to turn these accomplishments into being readily reproducible and affordable. More than ever I believe technology is vital to our success in this endeavor.

What is the biggest challenge on your plate currently?

Demand management. Wake Forest has come a long way in a relatively short time in this regard. Still, finding the appropriate thresholds and balance for responding to patient safety concerns, optimization requests and strategic initiatives remains a delicate dance between corporate culture, organizational goals, user engagement and capacity. It remains the most artful aspect of the business.

Thus far in your career, what do you feel is your greatest accomplishment?

There have been a host of quality projects for which I’ve been able to help leverage the Epic platform in a pivotal way. I particularly remember working with one group on improving door to lytic times for stroke patients, which resulted in dramatic improvements in a very short time. We were able to pilot it in a single institution and then quickly replicate the process across the entire organization, to the benefit of hundreds of patients and their families still to this day. It was this work that really made me a believer in the benefits of an integrated EHR. It’s where it became patently clear that this technology could be enormously impactful to the outcomes of our patients.

Do you have a mentor or mentors that helped contribute to your success?

There have been so many great, bright people I’ve had the privilege to work with over the years, too many to mention here. A few that particularly stand out include Andrew Mellon and Ferdinand Velasco, two great informaticists who I was lucky to learn from. Elliot Trotter is another – an ER colleague from Texas who has been a real pioneer in the use of scribes with an EHR. I owe a debt of gratitude to them all.